AB0178 INDICATORS OF DISEASE ACTIVITY DURING HOSPITALIZATION IN A RHEUMATOLOGICAL HOSPITAL IN PATIENTS WITH DIFFICULT-TO-TREAT RHEUMATOID ARTHRITIS
Authors: E. Matianova, A. Gordeev, Y. Olyunin, E. Galushko
Journal: Annals of the Rheumatic Diseases (2022)

Background Patients (pts) with Difficult-to-Treat Rheumatoid Arthritis (D2T) (EULAR 2021 criteria) are distinguished by a history of failure of two or more biological disease modifying antirheumatic drugs (bDMARDs)/targeted synthetic DMARDs (tsDMARD) with different mechanisms of action and a more aggressive course of RA generally. In this study, we wanted to identify differences in the manifestation of RA activity during an exacerbation of the disease in such pts, compared with similar pts, but not meeting the D2T EULAR criteria. Objectives Describe the features of manifestations of rheumatoid arthritis (RA) activity in pts with D2T. Methods In pts with RA, with ineffectiveness of bDMARD/tsDMARD taken before hospitalization, admitted to the V.A.Nasonova Research Institute of Rheumatology from January to December 2021 due to an RA exacerbation (n=113), the duration of morning stiffness in the joints, tender joint count (TJC), swollen joint count (SJC), VAS general health pt, ESR, blood CRP levels, and DAS28 calculated indices. Pts Patients Eligible for D2T RA EULAR 2021 were allocated to the D2T group (n=26/23%), the remaining pts were assigned to the C control group (n=87/77%). Pts at D2T and C were matched for sex, age (D2T: 44.6±14.1 years vs. C: 48.8±15.6 years; p&gt;0.05) and duration of RA (D2T: 15.8 ±11.4 years vs. C: 13.7±8.6 years, p&gt;0.05). Results Inflammatory activity in terms of CRP in D2T was significantly higher than in C (p=0.04). At the same time, the frequency of taking classical DMARDs in D2T was slightly lower (p&gt;0.05), and systemic glucocorticoids (GC) was significantly higher (OR=3.7 [1.3-10.8]; p=0.01). TJC, SJC, VAS general health pt, ESR, CRP, duration of morning joint stiffness, as well as the estimated DAS28 indices at the time of admission to the hospital in pts with D2T RA were comparable to those in C. (Table 1) Table 1. Indicators of disease activity and concomitant therapy in the study groups D2T (n=26) C (n=87) р TJC, М±SD 9.1±4.8 10.6±5.7 &gt;0.05 SJC, М±SD 6±3.7 6.6±4.5 &gt;0.05 VAS general health pt, М±SD, мм 66.2±11 66.9±12 &gt;0.05 ESR, Me [25; 75%], mm/hr 53.5 [8;98] 27 [14;56] &gt;0.05 CRP, Me [25; 75%], mg/l 28.3[3.5;67.7] 7.9[5.7;44.2] 0,04 DAS28 СОЭ , М±SD 5.5±1.3 5.7±1.1 &gt;0.05 DAS28 СРБ , М±SD 5.2±0.9 5.3±1 &gt;0.05 Duration of morning joint stiffness, min 120±79 135.5±94 &gt;0.05 Taken classic DMARDs, n/% 18 / 69,2 74 / 85,1 &gt;0.05 Taken GC per os n/% 21 / 80,8 46 / 52,9 OR=3,7 [1,3-10,8]; р=0,01 GC dose in terms of prednisolone, mg/day 7,6±4,1; 5 [5;10] 6,6±3; 5[5;10] &gt;0.05 Conclusion Pts with D2T RA during an exacerbation of the disease differed from other RA patients with the ineffectiveness of previous bDMARD/tsDMARD by a higher inflammatory activity in CRP (p=0.04) with a higher frequency of systemic GCs (OR=3,7 [1,3-10,8]; р=0,01). References [1]György Nagy et al. EULAR definition of difficult-to-treat rheumatoid arthritis. Ann Rheum Dis. 2021 Jan; 80(1): 31–35. doi: 10.1136/annrheumdis-2020-217344 Disclosure of Interests None declared